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Designating Petition
40th Assembly District
To the Board of Elections in the City of New york:
l, the undersigned, do hereby state that I am a duly enrolled voter of the Democratic Party and entiged to vote at the
next primary election of such party, to be held on September 12, 2O17; that my place o1 residence is truly stated
opposite my signature hereto, and I do hereby designate the following named p"i"on (or persons) as a can@ate (or
candidates) for the nomination of such party for public office or for eleition to a party posit'lon of such party.
NAME(S} OF CANDIDATE(S) PUBLIC OFFICE(S) ! PLACE(S) OF RESIDENGE
residing at 14340 41st Avenue, Apt. 3H, Flushing, County of Queens, New york 113SS {
g at 40-05 College Point Boulevard, Apt. 4A, Flushing, County of Queens, New York 11354
C/rlternate Delegates to Democratic Judicial Convefition from the 11th Judicial District
G a---
from rL-
the 40th Assembly District, Queens Gounty, New York
TES PLACES OF RESIDENCE
DEZ, residing at 33-30 149th Place, Flushing, Gounty of Queens, New York 11354
residing at. 1434A 4lstAvenue, Apt.3H, Flushing, Countyof Queens, NewYork 11355
N, residing at 148-09 Northern Boulevard, Apt. 2M, Flushing, County of Queens, New York 11354
AYNE, residing at 40-05 College Point Boulevard, Apt. 6E, Flushing, County of Queens, New York 11354
I do hereby appoint:
JOSEPH CROWLEY, residing at 48-24 65th Street, Woodside, Gounty of Glueens, New York 11377
JOHN C. LlU, residing at 145-21 29th Road, Flushing, County of Queens, New York 11354
MARY ANN DORSA, residing at 33-05 158th Street, Flushing, County of Queens, New York 11358
MARTHA FLORES-VAZQUEZ, residing at 1434A 41st Avenue, Apt. 3H, Flushing, County of Queens, New York 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature.
Enter Town or City
DATE NAME OF SIGNER except in NYC
enter C
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Printed Name t City of New York
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MAt(Y ANN U(rt(sA, resrolng ar JJ-u5 'l5utn ltreer, Ftusnlng, uounty or Llueens! New yorK 1.tJcu
MARTHA FLORES'VAZQUEZ, residing at 14340 41st Avenue, Apt. 3H, Ftushing, County of eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for itre abovi party positions in
accordance with the provisions of the election law,
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year piaced opposite my signature.
Enter Town or
DATE except in NYC
enter
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- state: t^ of
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dulv oualified voter of the
I am a State New York and
'
am an enrolled voter of the Democratic Party. I now reside at T-
in the City of NevlYprk, in the County of Queens. Each of the individuats whosetl'i'ff[:^tJlT'subscribed to this petition
sheet contain,nnr*J*,signatures, subscribed the same in my presence on the dates above indicated and identified himself
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall me to the same penalties as if I had been
'r",^')'*"'6
/ 15 ,^, of Witness
sheet to be valid.
lN WITNESS WHEREOF, I have hereunto set my hand, the dby and year placed opposite my signature.
Printed Name
2017
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City of New York
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Gounty of Queens
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Printed Name , b-cAlqlrf NY rt City of New York
Date .,2017
of Witness
sheet to be valid.
,lrT I,-. - PARKSTDE pnrrurrHC cb., lNC., 538 JOHNSON AVE.. BROOKLYN, NY (718) 443-7500 PAGE No. 7
trlAnl Altl! uvnoA, rvntutrt9 qt J0{J rugttt gatsg!, I tuatrrrtlrr gvurrry vt vugetr-, ttgy, avth I tuJo
MARTHA FLORES-VMQUEZ, residing at 14340 41st Avenue, Apt. 3H, Ftushing, County of Queens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year plirced opposite my signature.
Town or City
DATE except in NYC
enter
-o3 anANs sT" County of Queens
Printed Name I Fores*ff,'l/s,y'? //3 +5 City of New York
{, County S Queens
Printed Name ) City of New York
4, County of Queens
Printed Name ) City of New York
Gounty of Queens
Printed Name + City of New York
8. ___.___;?_911_.
County of Queens
Printed Name ) City of New York
9. County of Queens
Printed Name I City of New York
County of Queens
Printed Name I City of New York
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Printed Name I City of New York
County of Queens
Printed Name t City of New York
STATEMENT OF WITNESS
t
t, JCr*s &\ Lr n. G. state: I am a duly qualified voter of the State of New York and
am an enrolled voterof*ie O"rnoJritic Party. lnow reside at le: F. lzo*L 5I. lr+"t^l-l(fr---.Pr. Li;+.-f Pu L
in the City of New York, in the Gounty of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing cI- signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill ,n Number)
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.
Date l, / 1o ,2017
Witness identification information: The following information for the witness named above completed prior to filing with the Board of Elections in order for this petition
sheet to be valid.
PARKSTOE PRiNTTNG CO., tNC., 538 JOHNSON AVE., BROOKLYN, NY (718) 443-7500 PAGE No.--:-3
.dn,'ri,=r,iii,
rffiri#;i6X'i;:irAzaffiZ,
'L'ioi,ig'Ji;4ffi; fi;Jiii",-,iii. ;;;,U';i oJiJn', New york 355 11
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for the above Party Positions in
accordance with the provisions of the election law.
.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature.
Enter Town or
DATE NAME OF SIGNER except in NYG
(signature required) enter
?, County o1 Qr""n.
!?-(?{------,-?qt-,
Printed Name + *-1:2rl,f',ifr,n* City of New York
County of Queens
City of New York
Printed Name ) rsr3/1r,^ y t lgs
County of Queens
Printed Name ) Gity of New York
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Printed Name +
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2017 Au e^.^4 County of Queens
Gity of New York
Printed Name I
STATEMENT OF WITNESS
state: I am a duly qualified voter of the State of New York and
am an enrotted voter of,,1Xffi'#[:'l"tic Party. I now reside a1 rg'l R tz,.,tt^ .st A?,1,-lkr--{1,- l^,^^-l ?"-tl,
in the City of New, Y4rk, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing t \ signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill in Number)
or herself to be the individual who signed this sheet. I understand that this statement wlll be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
iluly sworn.
o*, (a
/ 1o ,rofi Signature of
Witness identification information: The following information for the witness named above completed prior to filing with the of Elections in order for this petition
sheet to be valid.
PARKSIDE pRtNTtNG CO., rNC., 538 JOHNSON AVE., BROOKLYN, NY (718) 443-7500 PAGE -" +
MARY ANN DORSA, residing at 33-05 f 58th Street, Flushing, County of eueens, Nerjv york 11gsg
MARTHA FLORES'VAZQUEZ, residing at14340 41st Avenue, Apt. 5H, Flushing, county of eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacaniies foritre above party positions in
accordance wiih the provisions of the election law.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placea opposite my signature.
3L[ ll\tu tu
Printed Name + c.rt.a^* Pnio T, K\11 t*5{ County of Queens
City of New York
14. J,t*7-E,zal:
---"---;ffi; |e.,m &741^ {+ County of Queens
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City of New York
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Printed Name ) City of New York
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City of New York
Printed Name ,
N44,{&n- p County of Queens
City of New York
STATEMENT OF WITNESS
l, lrl AWY CoN frtY
(Nare of Witness)
stite: I am a duly qualified voter of the State of New York and
amanenrolledvoteroftheDemocraticParty. lnowresideat llQ-a?Sa,,fop five* fLusll:att"- N/ ,{35-5-
ine
in the City of New York, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet containing "2'D signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Flll in Numbe0
or lrerself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.
oate }a"*zg
-7-- ,ro'r,
sheet to be valid.
City:
::Y:*, ^
':Lu.:'
City of New York County: Queens
PARKSIDE PRINTTNG co., rNC.. s3B JoHNSoN AVE., BRooKLyN, Ny (718) 443-7s00 PAGE No, 5
MARY ANN DoRsA, residing at 33-05 ,56th Street, Flushtng, county ot (lueens, New yorK
1135u
MARTHA FLORES'vAzQUEz, residing at 14340 41st Avenie, Apt. 5H, rlustring, County of
eueens, New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill ,r""n-"i". tor
itre a5ove earty eositions in
accordance with the provisions of the election law.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year piaced opposite my
signature.
NAME OF SIGNER Enter Town or
DATE
(signature required) except in NYG
enter C
>2 .zo,tz County of Queens
Printed Name , l.,t{ rt3kr City of New York
. ?,-9^"..e -Z-?-"".-,lPl-r- -
// Printed Name I
0q-St 3) fl*s Gounty of Queens
City of New York
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1zq.!! County of Queens
Printed Name t ?r/LL,-'L-z-;, City of New York
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Pririted
.2017
Name:+
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City of New York
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County of Queens
City of New York
County of Queens
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Printed Name:t City of New York
STATEMENT OF WITNESS
m AP-|
I COd A31 state: I am a duly qualified voter of the State of New York and
(Name of Wllness)
amanenrolledvoteroftheDemocraticParty.lnowresideal fi-' ,F/r.;tr's"t NY
/4'/'a7-Sa,,for"'o 1n"ffi 1t355
in the City of New York, in the County of Queens. Each of the individuals whose names are subscribed to this petition
sheet contai ning ' /"C signatures, subscribed the same in my presence on the dates above indicated and identified himself
(Fill in Number)
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been
duly sworn.
Date ,20'17
sheet to be valid.
-rS:Y};,* eARKSTDE eRINTTNG co., rNC., s38 JoHNSoN AVE., BRooKLyN, Ny (718) 443-7s00 PAGE *, J4-
drii#;t6ft;-r,AzAU;2,;;;;;';;i;;;;i ,;iil;;;/il'inl'ni*r'i,;, i;;"t';i d,lJJn", New york 11355
all of whom are enrolled voters of the Democratic Party as a committee to fill vacancies for itre above Party Poditions in
accordance with the provisions of the election law.
lN WITNESS WHEREOF, I have hereunto set my hand, the day and year placed opposite my signature:
Enter Town or City
DATE except in NYC
enter Coun
County of Queens
Gity of New York
County of Queens
City of New York
County of Queens
City of New York
County of Queens
City of New York
County of Queens
Printed Name * City of New York
County of Queens
--l-9,--_-____-----_-__..-.---_,_?-!J_
Printed Name I City of New York
County ol Queens
_.7L _.. _... _-_ _ _ _. _ __.- _- _ --.--; ?91!. -_
Printed Name ) City of New York
of Queens
Printed Name * of New York
STATEMENT OF WITNESS
r, I\a r state: I am a duly qualified voter of State New York and
,
am an enrolled voter of the
Each of the individuats whose'ffiffi[flH"'
or herself to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the
equivalent of air affidavit and, if it contains a material false statement,,shall subject me to tlq same penalties as if I had been
duly sworn.
-7t'r
oarc // (z? ,zott
Signature of Witness
sheet to be valid.
",:331.3r"- PARKSTDE pRiNTTNG co., rNc., s3B JoHNSoN AVE., BRooKLYN, NY (718) 443-7500 PAGE No.
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*QN1700044*
NOT FOR REPRODUCTION
3t2ot17 12:46 pn| 1643 I 5675 | FrankA. Eolz lll, Esq. (DEM)
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